Master of Public Health, Faculty of Public Health, Mahidol University
Master of Public Health, Faculty of Public Health, Mahidol University
MPH International Alumni Data Form
Dear alumni,
We are in the process to update our alumni information on our system including official website and publications and would like to request you to provide following information to update our alumni data. This information will be published on our official website, media, printed documents and other related publications. Kindly complete this form and send back to us at with your recent photo (please attach passport size photo separately).
We would also request you to forward this form to the MPH alumni you know in your country.
Alumni Information
Please Fill Following InformationPersonal Information
Nationality:
Title: Dr./Ms./Mr. / First Name: / Last Name:
Date of Birth (optional) / Month: / Day: / Year:
Contact Detail
PermanentMailing Address: / Street Name: / City: / State/Province/
District:
Zip Code: / Country: / Email:
MobilePhone Number:
(ie. country code/city code/phone number / land Line Number: / Fax: / Social Media ID (if any):
Face book
Academic Information
Year of MPH Start: / MPH Graduated Year:
Thesis/Thematic Paper Title:
Publication (s) since MPH graduation:If your research is published please specify journal name and year with web link, if possible
Current Academic Status (please update academic status after the MPH, if any)
Name of Most Recent Academic Degree: / Institution: / Country:
Career History
Past Employment
Job title:
1.
2. / Organization Name:
1.
2. / Job Focus Area:
1.
2. / Duration in Year/Month:
1.
2.
Current Employment Status:
Job Title: / Organization Name: / Job Focus area: / Based Country:
Do you know any Mahidol MPH alumni in your country? If yes,kindly provide information below and share this form to your friend for his/her updated information
Name of MPH alumni you know in your country: / Email: / Year of graduation:
Is there any Mahidol University MPH alumni network in your country? If yes please provide information below
Are you a member of Mahidol University MPH International alumni in your country? If yes, please provide brief information on alumni activities and your role in your country
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Dear Alumni, we are also planning to continue our regular alumni newsletter and would like to request you to provide information on your significant participation in career, academic or alumni activities in your country.
YOUR RECENT PHOTOPlease attach your photo either here or separate in email
Thank you for your kind cooperation,
Faculty of Public Health, Mahidol University, 420/1 Ratchawithi RD., Ratchathewi District, Bangkok 10400. Thailand